US11881312B2

Movatterモバイル変換

Info

Publication number: US11881312B2
Application number: US17/040,133
Authority: US
Inventors: Tomomi MUROZONO; Makiko FUMOTO; Hideki Fujisaki
Original assignee: Nihon Kohden Corp
Current assignee: Nihon Kohden Corp
Priority date: 2018-03-29
Filing date: 2019-03-27
Publication date: 2024-01-23
Also published as: CN111919263B; EP3776581A1; CN111919263A; US20210074433A1; WO2019189391A1; JP2019175285A; JP7267680B2

Abstract

A vital sign information sensor for acquiring vital sign information from a physiological tissue of a subject includes: a sensor element configured to acquire the vital sign information from the subject; and a memory storing URI information. The URI information is capable of gaining access to an electronic content provided by a WEB server disposed on a communication network. When the vital sign information sensor is communicably connected to a vital sign information display apparatus, the URI information is transmitted from the memory to the vital sign information display apparatus. The electronic content includes information relevant to the vital sign information sensor.

Description

TECHNICAL FIELD

The present disclosure relates to a vital sign information sensor and a vital sign information display system.

BACKGROUND ART

A pulse oximeter which can measure vital sign information (e.g. arterial oxygen saturation (SpO2), a pulse rate, etc.) of a subject (e.g., patient) using a probe mounted on a finger etc. of the subject has been disclosed (e.g., see JP-A-7-236625). According to the disclosure of JP-A-7-236625, the probe provided with a light emitter and a light receiver is mounted on the finger of the subject, so that the vital sign information of the subject can be acquired based on an electric signal acquired from the light receiver.

In such a case, there is a possibility that the medical worker cannot perform proper diagnosis using the vital sign information sensor. Thus, there is still room to further improve usability of the vital sign information sensor in terms of information relevant to the vital sign information sensor such as the operating manual etc. of the vital sign information sensor.

SUMMARY

The present disclosure provides a vital sign information sensor whose usability is improved and a vital sign information display system.

According to one or more aspects of the present disclosure, there is provided a vital sign information sensor for acquiring vital sign information from a physiological tissue of a subject.

The sensor comprises:

- a sensor element configured to acquire the vital sign information from the subject; and
- a memory storing URI information, wherein the URI information is capable of gaining access to an electronic content provided by as WEB server disposed on a communication network.

When the vital sign information sensor is communicably connected to a vital sign information display apparatus, the URI information is transmitted from the memory to the vital sign information display apparatus.

The electronic content includes information relevant to the vital sign information sensor.

According to one or more aspects of the present disclosure, there is provided a vital sign information display system.

The vital sign information display system comprises:

- a vital sign information sensor that acquires vital sign information from a physiological tissue of a subject; and
- a vital sign information display apparatus that is communicably connected to the vital sign information sensor.

The vital sign information sensor includes a sensor element configured to acquire the vital sign information from the subject,

The vital sign information display apparatus is configured to:

- acquire the vital sign intimation from the sensor element;
- acquire an electronic content from a WEB server disposed on a communication network with reference to URI information that can gain access to the electronic content provided by the WEB server; and
- display the acquired electronic content.

When the vital sign information sensor is communicably connected to the vital sign information display apparatus, the vital sign information display apparatus acquires the electronic content from the WEB server with reference to the URI information.

BRIEF DESCRIPTION OF DRAWINGS

FIG.1 is a schematic view showing a vital sign information display system according to an embodiment of the present invention (hereinafter referred to as present embodiment simply).

FIG.2 is a view showing an example of hardware configurations of a pulse oximeter and a vital sign information display apparatus according to the present embodiment.

FIG.3 is a flow chart for explaining an example of a method for visually presenting a medical worker with information relevant to an operating manual of the pulse oximeter.

FIG.4 is a flow chart for explaining another example of the method for visually presenting a medical worker with information relevant to an operating manual of the pulse oximeter.

DESCRIPTION OF EMBODIMENTS

An embodiment of the present invention (hereinafter referred to as present embodiment) will be described below with reference to the drawings.FIG.1 is a schematic view showing a vital signinformation display system100 according to the present embodiment. As shown inFIG.1, the vital signinformation display system100 includes a vitalsign information sensor1 that is mounted on a physiological tissue (e.g. a finger etc.) of a subject (e.g., patient), and a vital sign information display apparatus2 (hereinafter referred to as display apparatus2) that is communicably connected to the vitalsign information sensor1. A pulse oximeter will be described as an example of the vitalsign information sensor1 in the present embodiment.

The vitalsign information sensor1 has aprobe12, acable13 and aconnector16. Theprobe12 is, for example, wound around the finger of the subject to be thereby mounted on the finger of the subject. Thecable13 is configured so that theprobe12 and theconnector16 can be physically and electrically connected to each other through thecable13. When theconnector16 is inserted into aconnector insertion portion21 of thedisplay apparatus2, the vitalsign information sensor1 and thedisplay apparatus2 are physically and communicably connected to each other. Further, an electric signal outputted from thedisplay apparatus2 in a state in which the vitalsign information sensor1 and thedisplay apparatus2 in physically and communicably connected to each other is supplied to theprobe12 through theconnector16 and thecable13.

Thedisplay apparatus2 is configured to visually present vital sign information of the subject. Thedisplay apparatus2 may be a special apparatus a vital sign information monitor) for displaying a trend graph of vital sign information of the subject or may be, for example, a personal computer, a work station, a smart phone, a tablet, or a wearable device (e.g. a smartwatch, an AR glass, or the like) that can be mounted on the body (e.g. an arm, the head, etc.) of a medical worker. In addition, thedisplay apparatus2 is communicably connected to a WEB server4 through a communication network3. The communication network3 is constituted by at least one of the Internet, an LAN (Local Area Network) and a WAN (Wide Area Network). The WEB server4 is disposed on the communication network3 and configured to provide an electronic content of an HTML file (WEB page), a PDF file, an image file (e.g. a still image file and a moving image file, etc.) in accordance with an access request from a terminal. Particularly, the WEB server4 is configured to transmit the electronic content including information relevant to the vital sign information sensor1 (particularly, information relevant to an operating manual of the vital sign information sensor1) to thedisplay apparatus2 in accordance with an access request from thedisplay apparatus2.

Next, hardware configurations of the vitalsign information sensor1 and thedisplay apparatus2 will be described below with reference toFIG.2.FIG.2 is a view showing an example of the hardware configurations of the vitalsign information sensor1 and thedisplay apparatus2. As shown inFIG.2, the vitalsign information sensor1 includes amemory17, alight emitter18 and alight receiver19.

Thememory17 is, for example, an ROM (Read Only Memory). URL (Uniform Resource Locator) information indicating a URL accessible to an electronic content provided by the WEB server4 is stored in thememory17. The URL is constituted by, for example, a communication protocol, a domain name, a directory name, and a file name. Incidentally, the URL may include an IF address of the WEB server4 in place of the domain name. In addition, the URL information is stored as an example of URI (Uniform Resource Identifier) information in thememory17 in the present embodiment. However, URN (Uniform Resource Name) information may be stored in thememory17 in place of the URL information.

In addition, thememory17 is disposed, for example, on theconnector16 of the vitalsign information sensor1. Specifically, thememory17 may be mounted on a circuit board provided in theconnector16.

Thelight emitter18 is disposed on theprobe12 of the vitalsign information sensor1, and configured to emit light toward the physiological tissue such as the finger of the subject. For example, thelight emitter18 has a red light LED configured to emit red light, and an infrared light LED configured to emit infrared light. The red light LED and the infrared light LED are driven and controlled to emit the red light and the infrared light alternately. For example, when a pulsed current supplied to the infrared light LED is at a high level, a pulsed current supplied to the red light LED is at a low level. On the other hand, when the pulsed current supplied to the infrared light LED is at a low level, the pulsed current supplied to the red light LED is at a high level.

Thelight receiver19 is disposed on theprobe12 of the vitalsign information sensor1. Thelight receiver19 is configured to receive light that is radiated from thelight emitter18 and transmitted through or reflected by the physiological tissue such as the finger of the subject, so that thelight receiver19 can generate a pulse wave signal (electric signal) indicating pulse waves. For example, thelight receiver19 is a photoelectric conversion element such as a PD (photodiode). The number of thelight receivers19 is not limited particularly. For example, when thelight emitter18 has the red light LED and the infrared light LED, thelight receiver19 has photosensitivity to the red light radiated from the red light LED and the infrared radiated from the infrared light LED. Thelight emitter18 and thelight receiver19 function as a sensor element that is configured to acquire pulse wave information (an example of the vital sign information) relevant to the pulse waves of the subject. Additionally, the sensor element is not limited to thelight emitter18 and thelight receiver19. Type of the sensor element is not particularly limited as long as the sensor element is configured to acquire the vital sign information from the subject.

The red light is not absorbed very much by oxygenated hemoglobin (HbO2) contained in blood circulating in a blood vessel of the finger. On the other hand, the red light is absorbed very much by hemoglobin (Hb) contained in the blood. That is, when the blood contains a large amount of the oxygenated hemoglobin, a large quantity of the red light is transmitted through the finger and received by thelight receiver19. On the contrary, when the blood does not contain a large amount of the oxygenated hemoglobin, light intensity of the red light received by thelight receiver19 is small. Thus, the light intensity of the red light received by thelight receiver19 changes in accordance with a ratio of the oxygenated hemoglobin in the blood. On the other hand, the infrared light is not absorbed very much by the oxygenated hemoglobin and the hemoglobin. More specifically, there is no large difference between an absorption coefficient of the oxygenated hemoglobin for the infrared light and an absorption coefficient of the hemoglobin for the infrared light. Therefore, an SpO2 value of the subject can be calculated by use of a ratio between the light intensity of the red light received by thelight receiver19 and the light intensity of the infrared light received by thelight receiver19.

In addition, thedisplay apparatus2 includes asensor interface23, acontroller24, astorage device25, anetwork interface26, aninput operation section27, adisplay section28, a UPS (Global Positioning System)29 and apower supply section30. These elements except thepower supply section30 are communicably connected to one another through abus38.

Thesensor interface23 is communicably connected to the vitalsign information sensor1. Thesensor interface23 includes areader32, a drivingcircuit33, ananalog processor36, and anAD converter37. Thereader32 is configured to acquire the URL information stored in thememory17 when the vitalsign information sensor1 is communicably connected to thedisplay apparatus2. In other words, the UAL information is transmitted from thememory17 to thereader32. The drivingcircuit33 is configured to control a driving current (pulsed current) supplied to thelight emitter18 based on a control signal outputted from thecontroller24. For example, the drivingcircuit33 is configured to control a timing of the pulsed current supplied to the red light LED and a timing of the pulsed current supplied to the infrared light LED.

Theanalog processor36 is configured to amplify the pulse wave signal (a photoelectrically converted electric signal) outputted from thelight receiver19, and to filter a noise component (e.g. a high frequency component) of the amplified pulse wave signal. TheAD converter37 is configured to convert the pulse wave signal (analog signal) outputted from theanalog processor36 into a digital signal based on the control signal outputted from thecontroller24.

Thecontroller24 has a processor and a memory. The processor includes at least one of a CPU (Central Processing Unit), a GPU (Graphics Processing Unit) and an MPU (Micro Processing Unit). The memory includes an RAM (Random Access Memory) and an ROM. The processor may be configured to develop a program designated from various programs incorporated into thestorage device25 or the ROM onto the RAM, and execute various processings in cooperation with the RAM.

Thecontroller24 is configured to control various operations of thedisplay apparatus2. In addition, thecontroller24 can receive the digital signal of the pulse wave signal (hereinafter referred to as digital signal simply) from theAD converter37, and acquire pulse wave data in which the digital signal and time information are associated with each other by use of a timer function of the processor. The pulse wave data have information about the intensities of the lights received by thelight receiver19, and the time information. The pulse wave data may include pulse wave data associated with the red light, and pulse wave data associated with the infrared light. The pulse wave data may be stored in the RAM or thestorage device25.

In addition, thecontroller24 may generate SpO2 value data indicating a temporal change of the SpO2 value and/or pulse rate data indicating a temporal change of a pulse rate, based on the generated pulse wave data. Thecontroller24 can generate the SpO2 value data based on the pulse wave data associated with the red light and the pulse wave data associated with the infrared light. Thus, thecontroller24 can acquire the pulse wave data, the SpO2 value data and/or the pulse rate data based on the digital signal outputted from theAD converter37.

Thestorage device25 is, for example, a storage device such as an HDD (Hard Disk Drive), an SSD (Solid State Drive), a flash memory, or the like. Thestorage device25 is configured to store the programs or various data. For example, the pulse wave data, the SpO2 value data and/or the pulse rate data may be stored in thestorage device25.

Thenetwork interface26 is configured to connect thedisplay apparatus2 to the communication network3. Specifically, thenetwork interface26 may include various wired connection terminals for communicating with the WEB server4 through the communication network3. In addition, thenetwork interface26 may include various processing circuits and an antenna or the like for making wireless connection with an access point. A wireless communication standard between thedisplay apparatus2 and the access point is, for example, Wi-Fi (registered trademark), Bluetooth (registered trademark), ZigBee (registered trademark) or LPWA.

Thedisplay section28 may be a display device such as a liquid crystal display or an organic EL display, or may be a display device such as a transmissive type or non-transmissive type head mount display mounted on the head of an operator. Further, thedisplay section28 may be a projector device projecting video onto a screen. Theinput operation section27 is configured to accept an input operation of the medical worker operating thedisplay apparatus2 and to generate an instruction signal corresponding to the input operation. Theinput operation section27 is, for example, a touch panel disposed to be superimposed on thedisplay section28, an operation button attached to a housing, a mouse and/or a keyboard, etc. After the instruction signal generated by theinput operation section27 is transmitted to thecontroller24 through thebus38, thecontroller24 executes a predetermined operation in accordance with the transmitted instruction signal. TheGPS29 is configured to acquire position information (longitude, latitude) indicating a current position of thedisplay apparatus2. Thepower supply section30 is configured to supply electric energy to the respective elements of thedisplay apparatus2.

Next, an example of a method for visually presenting a medical worker with information relevant to an operating manual of the vital sign information sensor1 (an example of the information relevant to the vital sign information sensor1) will be described with reference toFIG.3.FIG.3 is a flow chart for explaining the example of the method for visually presenting the medical worker with the information relevant to the operating manual of the vitalsign information sensor1.

In a step S1 as shown inFIG.3, thecontroller24 determines whether the vitalsign information sensor1 has been physically connected to thedisplay apparatus2 or not. Particularly, thecontroller24 determines whether theconnector16 of the vitalsign information sensor1 has been inserted into theconnector insertion portion21 of thedisplay apparatus2 or not. When a result of the determination of the step S1 is NO, thecontroller24 executes the determination processing of the step S1 again.

Next, thecontroller24 acquires URL information that can gain access to an electronic content provided by the WEB server4 from thememory17 through the reader32 (step S3). In addition, in processing in and after the step S3, thecontroller24 generates pulse wave data, SpO2 value data and/or pulse rate data based on a pulse wave signal after having acquired the pulse wave signal front the vital sign information sensor1 (particularly the light receiver19) through thesensor interface23 in real time. Thecontroller24 displays a trend graph of the pulse wave data etc. on thedisplay section28. The trend graph displayed on thedisplay section28 may be updated in real time.

Next, in a step S4, thecontroller24 refers to the URL information acquired from thememory17 to thereby acquire an electronic content including information relevant to the operating manual of the vitalsign information sensor1 from the WEB server4 that is disposed on the communication network3 through thenetwork interface26. In this regard, firstly thecontroller24 acquires an IP address of the WEB server4 corresponding to a domain name of the URL information from a DNS server. Next, thecontroller24 refers to the acquired IP address of the WEB server4 to thereby transmit an access request of the electronic content to the WEB server4. Next, the WEB server4 transmits the electronic content to thedisplay apparatus2 in accordance with the access request of the electronic content issued from thedisplay apparatus2.

Here, the electronic content is a concept including an electronic file such as an HTML file, a PDF file, a moving image file, or the like. In addition, the information relevant to the operating manual of the vitalsign information sensor1 may be information indicating the operating manual of the vitalsign information sensor1, or may be information indicating a link to another electronic content (e.g. a PDF file etc.) indicating the operating manual. In this regard, when the acquired electronic content includes information indicating the link to the other electronic content indicating the operating manual, the medical worker designates the link through theinput operation section27 so that thedisplay apparatus2 can acquire the other electronic content indicating the operating manual from the WEB server4.

Next, thecontroller24 displays the electronic content acquired from the WEB server4 on thedisplay section28 by use of a WEB browser (step S5). Thus, the information relevant to the operating manual of the vitalsign information sensor1 is visually provided to the medical worker through thedisplay section28.

According to the present embodiment, when the vitalsign information sensor1 is communicably connected to thedisplay apparatus2, the URL information is transmitted from thememory17 to thedisplay apparatus2. Next, thedisplay apparatus2 can refer to the URL information to acquire the electronic content including the in formation relevant to the operating manual of the vitalsign information sensor1 from the WEB server4 disposed on the communication network3. Accordingly, even a medical worker who does not have much experience in using the vitalsign information sensor1 can check the information relevant to the operating manual of the vitalsign information sensor1 through thedisplay section28 of the display apparatus2 (specially the WEB browser) without preliminarily preparing the prints etc. of the operating manual of the vitalsign information sensor1. Thus, it is possible to provide the vitalsign information sensor1 whose usability is improved, thedisplay apparatus2 and the vital signinformation display system100.

In addition, the electronic content acquired from the WEB server4 may include information indicating operating manuals of the vitalsign information sensor1 written in a plurality of languages. For example, assume here that the electronic content includes an operating manual of the vitalsign information sensor1 written in Japanese and an operating manual of the vitalsign information sensor1 written in Chinese. In this case, a Japanese medical worker can browse the operating manual of the vitalsign information sensor1 written in Japanese, while a Chinese medical work can browse the operating manual of the vitalsign information sensor1 written in Chinese. Thus, any of the medical workers can browse the information relevant to the vitalsign information sensor1 in the plurality of languages through thedisplay apparatus2. Accordingly, it is possible to provide the vitalsign information sensor1 whose usability is improved, thedisplay apparatus2 and the vital signinformation display system100.

Next, another example of the method for visually presenting a medical worker with information relevant to an operating manual of the vitalsign information sensor1 will be described with reference toFIG.4.FIG.4 is a flow chart for explaining the other example of the method for visually presenting the medical worker with the information relevant to the operating manual of the vitalsign information sensor1. This example is different from the method shown inFIG.3 in that URL information which should be referred to is determined in accordance with position information of thedisplay apparatus2.

In a step S10 as shown inFIG.4, thecontroller24 determines whether the vitalsign information sensor1 has been physically connected to thedisplay apparatus2 or not. When a result of the determination of the step S10 is YES, thecontroller24 establishes communication with the vital sign information sensor1 (step S11). Next, thecontroller24 acquires pieces of URL information from thememory17 through the reader (step S12). Here, each of the pieces of URL information can gain access to a corresponding one of electronic contents. Further, each of the electronic contents includes information relevant to an operating manual of the vitalsign information sensor1 written in a corresponding one of languages. For example, assume here that the WEB server4 has stored electronic contents A to C. In this case, here, the electronic content A includes an operating manual of the vitalsign information sensor1 written in Japanese. The electronic content B includes an operating manual of the vitalsign information sensor1 written in English. The electronic content C includes an operating manual of the vitalsign information sensor1 written in Chinese. In this case, a piece of URL information that can gain access to the electronic content A, a piece of URL information that can gain access to the electronic content B, and a piece of URL information that can gain access to the electronic content C may be also stored in thememory17. In addition, each of the pieces of URL information is associated with a corresponding one of the official languages. That is, each of the pieces of URL information has a piece of metadata indicating a corresponding official language. For example, the piece of URL information that can gain access to the electronic content B has a piece of metadata indicating English as the official language.

Next, thecontroller24 acquires position information of thedisplay apparatus2 by use of the GPS29 (step S13). Then, thecontroller24 selects one of the pieces of URL information acquired from thememory17 based on the acquired position information of the display apparatus2 (step S14). In this regard, thecontroller24 specifies an official language used in a region (e.g. a country etc.) where thedisplay apparatus2 is currently positioned, based on the position information of thedisplay apparatus2. Next, thecontroller24 refers to the respective pieces of metadata for the pieces of URL information to select one piece of URL information associated with the specified official language from the pieces of URL information. For example, assume that thedisplay apparatus2 is currently positioned in the USA. In this case, thecontroller24 specifies the official language as English based on the position information of thedisplay apparatus2. Next, thecontroller24 refers to the respective pieces of metadata for the pieces of URL information to thereby select one piece of URL information associated with English from the pieces of information.

Next, thecontroller24 refers to the selected piece of URL information to thereby acquire an electronic content corresponding to the selected piece of URL information from the WEB server4 disposed on the communication network3 through the network interface26 (step S15). In other words, thecontroller24 acquires an electronic content including information relevant to the operating manual of the vitalsign information sensor1 written in the official language corresponding to the position information of thedisplay apparatus2 from the WEB server4. For example, thecontroller24 refers to the piece of URL information associated with English to thereby acquire an electronic content including the information relevant to the operating manual written in English.

Then, thecontroller24 displays the electronic content acquired from the WEB server4 on thedisplay section28 by use of the WEB browser (step S16). Thus, the information relevant to the operating manual of the vitalsign information sensor1 written in the official language corresponding to the position information of thedisplay apparatus2 is visually provided to the medical worker through thedisplay section28.

According to the present embodiment, after one of the pieces of URL information has been selected based on the position information of thedisplay apparatus2, the electronic content corresponding to the selected piece of URL information is acquired. Thus, the medical worker can check the information relevant to the operating manual of the vitalsign information sensor1 in the language associated with the position information of thedisplay apparatus2 through thedisplay apparatus2. For example, assume that the medical worker operating thedisplay apparatus2 is in the USA. In this case, the medical worker can check the operating manual written in English that is the official language of the USA. Accordingly, it is possible to provide the vitalsign information sensor1 whose usability is improved, thedisplay apparatus2 and the vital signinformation display system100.

Incidentally, in the example, thecontroller24 acquires the position information of thedisplay apparatus2 by use of theGPS29. However, thecontroller24 may acquire the position information of thedisplay apparatus2 based on an IP address of thedisplay apparatus2 in place of theGPS29. In this case, thecontroller24 can at least specify the region (e.g. the country etc.) where the display apparatus is currently positioned based on the IP address of thedisplay apparatus2. Accordingly, thecontroller24 can specify the official language used in the region where thedisplay apparatus2 is currently positioned.

In addition, the example of the method for visually presenting the medical worker with the information relevant to the operating manual of the vital sign information sensor as an example of the information relevant to the vitalsign information sensor1 has been described in the present embodiment. However, the present embodiment is not limited thereto. For example, the information relevant to the vitalsign information sensor1 may include at least one of i) the information relevant to the operating manual of the vitalsign information sensor1, ii) information relevant to specifications of the vitalsign information sensor1, iii) information relevant to a pamphlet of the vitalsign information sensor1, and iv) information relevant to the subject to which the vitalsign information sensor1 is attached. In this case, the electronic content acquired from the WEB server4 may include at least one of the aforementioned pieces of information i) to iv).

Further, in the description of the present embodiment, thedisplay apparatus2 acquires the URL information from thememory17 of the vitalsign information sensor1 after establishing communication with the vitalsign information sensor1. However, the present embodiment is not limited thereto. For example, the URL information may be stored in the memory of thecontroller24 or thestorage device25. In this case, after establishing communication with the vitalsign information sensor1, thecontroller24 may refer to the URL information stored in the memory of thecontroller24 or thestorage device25 so that thecontroller24 can acquire the electronic content from the WEB server4. Further, thecontroller24 may select one of the pieces of URL information stored in the memory of thecontroller24 or thestorage device25 based on the position information of thedisplay apparatus2 after acquiring the position information of thedisplay apparatus2.

In addition, the vitalsign information sensor1 has been described as an example of the vital sign information sensor in the present embodiment. However, the kind of the vital sign information sensor is not limited to the pulse oximeter. For example, an electrocardiogram (ECG) sensor acquiring electrocardiogram information of the subject, a CO2 sensor, a blood pressure measurement cuff, an electroencephalograph electrode, a body temperature measurement probe, or the like, may be used as a vital sign information sensor in place of the pulse oximeter. In addition, each of such vital sign information sensors may be a non-contact sensor which does not have to be mounted on the subject.

Although the embodiment of the present invention has been described above, the technical scope of the present invention should not be interpreted limitedly by the description of the present embodiment. It should be understood by those skilled in the art that the present embodiment is merely exemplified but various changes can be made on the embodiment within the scope of the claimed inventions. The technical scope of the present invention should be determined based on the scope of the claimed inventions and the scope of equivalents thereof.

This application is based on Japanese Patent Application No. 2018-064878 filed on Mar. 29, 2018, the entire contents of which are incorporated herein by reference.